{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:59:32Z","timestamp":1790420372008,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,7,20]],"date-time":"2016-07-20T00:00:00Z","timestamp":1468972800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,7,20]],"date-time":"2016-07-20T00:00:00Z","timestamp":1468972800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2016,7,20]],"date-time":"2016-07-20T00:00:00Z","timestamp":1468972800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","arthroscopyjournal.org","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine the diagnostic value of the 3\u2010Pack examination for biceps\u2010labrum complex (BLC) disease, assess interobserver reliability, and generate an evidence\u2010based diagnostic and therapeutic algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 145 consecutive patients were enrolled in this prospective comparative study. The study included 116 chronically symptomatic patients indicated for arthroscopic subdeltoid transfer of the long head of the biceps tendon to the conjoint tendon and 29 asymptomatic comparison subjects. Each patient underwent examination that included the 3\u2010Pack (active compression test [O'Brien sign], throwing test, and bicipital tunnel palpation) and traditional examination (Speed test; Yergason test; full can test; empty can test) in a blinded, randomized fashion by 3 investigators. Intraoperative BLC disease was prospectively categorized by location (inside, junctional, or bicipital tunnel).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>3\u2010Pack tests were highly sensitive (73% to 98%), but less specific (46% to 79%) for BLC in all 3 locations than some of the traditional tests, which were less sensitive (20% to 67%), but more specific (83% to 100%) for BLC disease in all 3 locations. With regard to hidden bicipital tunnel lesions, palpation and O'Brien sign were highly sensitive (97.8% and 95.7% respectively) and revealed high negative predictive value (NPV, 96.4% and 92.6% respectively). Speed and Yergason tests, conversely, were poorly sensitive but had high specificities (86.7% and 97.9%, respectively) and positive predictive value (76% and 92.3%, respectively). Inter\u2010rater reliabilities were substantial to almost perfect for the 3\u2010Pack examination (kappa 70% to 85%) and fair to moderate for the 4 traditional examinations (kappa 25% to 56%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 3\u2010Pack has excellent inter\u2010rater reliability, sensitivity, and NPV and is a critical screening tool for BLC disease in all zones. Hidden extra\u2010articular bicipital tunnel disease can reliably be excluded based on negative tenderness to palpation or a negative O'Brien sign (NPV 93% to 96%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, case control study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2016.05.015","type":"journal-article","created":{"date-parts":[[2016,7,21]],"date-time":"2016-07-21T22:04:02Z","timestamp":1469138642000},"page":"28-38","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":70,"title":["The \u201c3\u2010Pack\u201d Examination Is Critical for Comprehensive Evaluation of the Biceps\u2010Labrum Complex and the Bicipital Tunnel: A Prospective Study"],"prefix":"10.1002","volume":"33","author":[{"given":"Samuel A.","family":"Taylor","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley M.","family":"Newman","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Dawson","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli Ann","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Bowers","sequence":"additional","affiliation":[{"name":"Burlington County Orthopaedic Specialists Mt Laurel New Jersey U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D.","family":"Fabricant","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,7,20]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.10.017"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2011.01.037"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513477363"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513520122"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.11.020"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514540273"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2011.01.003"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2004.01.003"},{"key":"e_1_2_2_10_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.170.6.9609174"},{"key":"e_1_2_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-009-0660-7"},{"key":"e_1_2_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2005.03.032"},{"key":"e_1_2_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.07.028"},{"key":"e_1_2_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2007.07.030"},{"key":"e_1_2_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465980260050201"},{"key":"e_1_2_2_16_2","volume-title":"Master techniques in orthopaedic surgery\u2014the shoulder","author":"Taylor S.A.","year":"2012"},{"key":"e_1_2_2_17_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-196648080-00003"},{"key":"e_1_2_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2004.01.008"},{"key":"e_1_2_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2005.02.008"},{"key":"e_1_2_2_20_2","first-page":"672","article-title":"Entrapment of the long head of the biceps: The \u201chourglass biceps.\u201d Another cause of pain and locking of the shoulder","volume":"89","author":"Boileau P.","year":"2003","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"key":"e_1_2_2_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509355142"},{"key":"e_1_2_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510393942"},{"key":"e_1_2_2_23_2","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.09.026"},{"key":"e_1_2_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.05.044"},{"key":"e_1_2_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.07.025"},{"key":"e_1_2_2_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514554193"},{"key":"e_1_2_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2011.08.313"},{"key":"e_1_2_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514547226"},{"key":"e_1_2_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2010.01.024"},{"key":"e_1_2_2_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0b013e3181824edf"},{"key":"e_1_2_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2015.08.005"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806316302493?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806316302493?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2016.05.015","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2016.05.015","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2016.05.015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T08:45:59Z","timestamp":1773564359000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2016.05.015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,20]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,1]]}},"alternative-id":["10.1016\/j.arthro.2016.05.015"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2016.05.015","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,20]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The \u201c3-Pack\u201d Examination Is Critical for Comprehensive Evaluation of the Biceps-Labrum Complex and the Bicipital Tunnel: A Prospective Study","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2016.05.015","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2016 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}